Benjamin Lickteig, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4782 Issued in MA

Practice address

870 Providence Hwy
Dedham, MA 02026-6806

Phone

(781) 329-0067

Fax

(781) 320-5603

NPI assigned

Oct 21, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lickteig Family Eyecare PCGroup PAC ID 6002096328, 14 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: benjamin.lickteig@direct.revolutionehr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lickteig Family Eyecare PC

  • Optometrist
  • Dedham, MA
  • NPI 1063720498
  Medicare reassignment Care Compare group NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354752000000",
    "number": "1962738286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "870 PROVIDENCE HWY",
            "city": "DEDHAM",
            "state": "MA",
            "postal_code": "020266806",
            "telephone_number": "781-329-0067",
            "fax_number": "781-320-5603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 PROVIDENCE HWY",
            "city": "DEDHAM",
            "state": "MA",
            "postal_code": "020266806",
            "telephone_number": "781-329-0067",
            "fax_number": "781-320-5603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICKTEIG",
        "first_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-21",
        "last_updated": "2012-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Whitney Lew
• Madeline Lewis
• Lexington Eye Associates - Optical
• Tomas F Lichauco, M.D.
• Lickteig Family Eyecare PC
• Lifetime Physical Therapy
• Deloris Yvonne Linton, LPN
• Jennifer Llado, CCC-SLP
• Sharla Louise Lloyd Halperin, BS, IBCLC
• On-Yee Lo, PHD

• Optometrist in Dedham, MA
• Providers in Dedham, MA by specialty
• Optometrist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.